Verordnen wir ausreichend Physikalische Medizin? Aktuelle Daten aus der Kerndokumentation der Arbeitsgemeinschaft Regionaler Kooperativer Rheumazentren

Heat therapy in rheumatic and musculoskeletal diseases - an overview of clinical and molecular effects

Rheumatic and musculoskeletal diseases (RMDs) usually lead to morphological and functional deficits of various extend, increased morbidity and a considerable loss of quality of life. Modern pharmacological treatment has become effective and can stop disease progression. Nonetheless, disease progression is often only slowed down. Moreover, pharmacological treatment does not improve functionality per se. Therefore, multimodal treatment of rheumatic disorders with physical therapy being a key element is of central importance for best outcomes. In recent years, research into physical medicine shifted from a sole investigation of its clinical effects to a combined investigation of clinical effects and potential changes in the molecular level (e.g., inflammatory cytokines and the cellular autoimmune system), thus offering new explanations of clinical effects of physical therapy. In this review we provide an overview of studies investigating different heat applications in RMDs, their effect on disease activity, pain and their influence on the molecular level.

[With RheMIT rheumatology centers can participate in the German national database-Expansion of the long-term rheumatological documentation]

The national database (NDB) of the German regional collaborative rheumatology centers was switched to the RheMIT documentation software last year. Rheumatology centers that already use RheMIT for care contracts or other research projects can therefore use the software to also participate in the NDB. Experiences from a hospital, a medical care center and a specialist practice show how the changeover to RheMIT from an existing documentation system or a new participation in the NDB with RheMIT can be implemented. The NDB team at the German Rheumatism Research Center in Berlin (DRFZ) welcomes new participating rheumatology centers.

[Development of quality standards for patients with rheumatoid arthritis for use in Germany]

Despite a qualitatively and structurally good care of patients with rheumatoid arthritis (RA) in Germany, there are still potentially amendable deficits in the quality of care. For this reason, the German Society for Rheumatology (DGRh) has therefore decided to ask a group of experts including various stakeholders to develop quality standards (QS) for the care of patients with RA in order to improve the quality of care. The QS are used to determine and quantitatively measure the quality of care, subject to relevance and feasibility. The recently published NICE and ASAS standards and a systematic literature search were used as the basis for development. A total of 8 QS, now published for the first time, were approved with the intention to measure and further optimize the quality of care for patients with RA in Germany.

[Prescription frequency of physical therapy for inflammatory rheumatic diseases]

Zielsetzung

Es erfolgte die Untersuchung der Verordnungshäufigkeit von ambulanter physikalischer Therapie (PT) bei Versicherten mit der Diagnose einer rheumatoiden Arthritis (RA), axialen Spondyloarthritis (axSpA), Psoriasisarthritis (PsA) oder eines systemischen Lupus erythematodes (SLE) in den Jahren 2005 bis 2020.

Methodik

Eingeschlossen wurden erwachsene Versicherte der BARMER Krankenversicherung mit Diagnose einer RA (ICD-10: M05, M06), axSpA (M45), PsA (M07.0-3) oder SLE (M32.1,8,9). PT wurden über das bundeseinheitliche Positionsnummernverzeichnis für Heilmittelleistungen identifiziert. Berichtet wird der Anteil an Personen mit mindestens einer Verordnung von PT in den Jahren 2005 bis 2020 nach Alters- und Geschlechtergruppen. Außerdem wurden die Anzahl und die Dauer der Verschreibungen verglichen, und es wurde analysiert, ob Versicherte mit fachärztlichem Kontakt häufiger PT erhalten.

Ergebnisse

Im Jahr 2020 erhielten 43 % (SLE), 46 % (RA, PsA) und 49 % (axSpA) der Versicherten mindestens eine PT-Verordnung. Am häufigsten wurde Krankengymnastik rezeptiert (37 %), gefolgt von manueller Therapie (14 %) und Thermotherapie (10 %). Seit 2005 hat sich der Anteil der Versicherten, die Krankengymnastik erhalten, nicht verändert. Manuelle Therapie wird zunehmend verordnet (+7 %), während Massagen (−10 %), Thermotherapie (−7 %) und Elektrotherapie (3 % in 2005, 2 % in 2020) rückläufig sind (Zahlen zu RA). Auch die Anzahl der Verschreibungen hat sich seit 2010 nicht wesentlich verändert. Versicherte in orthopädischer Betreuung erhalten häufiger PT als Versicherte in hausärztlicher oder internistisch-rheumatologischer Betreuung; 61- bis 80-jährige Patientinnen werden am häufigsten mit PT behandelt.

Schlussfolgerung

Etwas weniger als die Hälfte aller Versicherten mit RA-, axSpA-, PsA- oder SLE-Diagnose erhalten eine ambulante Verordnung von PT. Dieser Anteil hat sich in den letzten 15 Jahren kaum verändert.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00393-022-01180-x) enthält die Tabellen S1–S3 und die Abbildungen S1–S2.

[Development of quality standards for patients with axial spondyloarthritis for use in Germany]

Quality standards (QS) are measurable constructs designed to quantify gaps in care and subsequently to improve quality of care. The Assessment of SpondyloArthritis International Society (ASAS) recently generated and published international QS for the management of patients with axial spondyloarthritis (axSpA) for the first time. The German Society of Rheumatology (DGRh) then decided to translate, review and possibly adopt these standards by a group of experts from different care settings. Against this background, national QS for the management of patients with axSpA for Germany were developed for the first time. The main focus was on feasibility and practical relevance. Ultimately, nine QS were defined with which the quality of care in Germany can and should be measured and improved.

Long-term trends in rheumatology care : Achievements and deficits in 25 years of the German national rheumatology database

BACKGROUND

Since 1993, data on the care and quality of life of patients with inflammatory rheumatic diseases have been collected in the German National Database (NDB) of the regional collaborative rheumatology centers.

OBJECTIVE

In this review long-term trends on treatment, disease activity and gainful employment of the most common inflammatory rheumatic diseases are presented and the most important analyses from 25 years of the NDB are summarized.

METHODS

Between 15 and 17 rheumatological institutions take part in the NDB and once a year collect data from a total of more than 10,000 patients. The rheumatologists document the disease status and care, the patients report on their state of health and the effects of the disease.

RESULTS

The biologics era at the beginning of the twenty-first century has led to changes in the therapeutic spectrum of most inflammatory rheumatic diseases, especially in rheumatoid arthritis and ankylosing spondylitis. Some basic therapies formerly used are hardly used anymore and glucocorticoids are used less frequently. Methotrexate has remained the standard therapy for rheumatoid arthritis over the years. Nowadays, nearly 30% of patients with rheumatoid arthritis receive treatment with biologics. Disease activity, functional and social restrictions have decreased across all diseases.

CONCLUSION

The improved health status of many patients with rheumatic diseases confirms the high level of care provided by the rheumatism centers involved in the NDB. The increasing specification of measuring instruments and the standardization of documentation systems are major challenges that the NDB will have to face in the coming years if it is to remain in the digital age.

[Non-drug treatment of rheumatoid arthritis : An analysis of claims data and a survey of insured persons (Project PROCLAIR)]

BACKGROUND

Only small amounts of data are available on the prescription frequency of physical therapies (PT) for patients with rheumatoid arthritis (RA).

OBJECTIVE

The aim of the study was to evaluate prescription frequencies of PT considering functional status and sociodemographic factors.

MATERIAL AND METHODS

A total of 98,963 adults diagnosed with RA in 2013 were identified in claims data from the BARMER health insurance. A questionnaire was sent to a representative sample of 6193 people requesting information on the disease status. Of these 2535 persons were included who agreed to the linking of the questionnaire and claims data and who confirmed a diagnosis of RA. From the routine claims data the prescription of PT and occupational therapy as well as the medical discipline of the prescribing physician were analyzed. Multivariable logistic regression was conducted to determine which variables (age, sex, M05/M06 diagnosis, residential area, income, functional status and rheumatological care) were associated with the use of PT.

RESULTS

In 2015 a total of 47% of the study population received PT (35% physiotherapy, 15% thermotherapy, 15% manual therapy, 2% electrotherapy and 6% massage) and 3% occupational therapy. Of the PT prescriptions 37% were issued by general practitioners, 27% by orthopedists and 18% by rheumatologists. Women and persons living in the eastern states of Germany and patients with high functional impairment were prescribed PT more often. Income, educational status, seropositivity and rheumatological care did not have any influence on the frequency of prescription of PT.

CONCLUSION

There are deficits in the outpatient prescription of PT but without indications of an undersupply of population groups due to low socioeconomic status. In contrast to the prescription of disease-modifying antirheumatic drug (DMARD) treatment, PT is predominantly prescribed by general practitioners.

[Physical therapy options in rheumatic diseases: what is evidence-based?]

Rheumatic diseases usually progress towards morphological and functional deficits and thus cause impairment of physical health and function. Based on this fact, physiotherapeutic options are elementary and indispensable. This article focuses on the significance and importance of physiotherapy in inflammatory and degenerative rheumatic diseases. Furthermore, an overview is presented on the consequences of rheumatic diseases, the reality of supply of physiotherapy, the principles and therapeutic options, and the evidence.